REPAIR DEVICE FOR DEPLOYING ANCHORS INTO TISSUE
A tissue repair device is disclosed. The tissue repair device can include any one or combination of features including an end effector and an actuator. A deformable first anchor and a deformable second anchor can be captured by the end effector. The actuator can selectively engage the first anchor and the second anchor in a series. The actuator can deploy the first anchor from the end effector into tissue and then can be selectively moveable to engage and deploy the second anchor from the end effector into the tissue.
This application claims the benefit of U.S. Provisional Patent Application Ser. No. 63/331,328, filed on Apr. 15, 2022, the benefit of priority of which is claimed hereby, and which is incorporated by reference herein in its entirety.
FIELD OF THE DISCLOSUREThe present disclosure relates to deploying anchors for bone or tissue repair surgery.
BACKGROUND OF THE DISCLOSUREIn the human body, tissue can require repair. Such tissue includes bone, muscles, tendons, ligaments and cartilage. Forceful twisting, trauma or rotation of the knee, shoulder (or other joint) can tear or otherwise damage tissue. A surgical repair of the tissue may be required. Such repair can include suturing. Various assemblies have been developed for facilitating suturing and are effective for their intended purposes. Nevertheless, tissue repair assemblies for facilitating suturing are still desirable.
SUMMARYVarious tissue repair devices comprising suture anchor deployment devices are disclosed herein. Techniques related to these devices use are also disclosed. The devices disclosed include some that can deploy multiple anchors into tissue or bone. This can improve surgical time and reduce complexity.
Tissue repair devices (commonly called inserters) are used for suture anchor deployment into tissue (including bone or soft tissue). The present inventors propose inserters that can deploy multiple suture anchors into tissue. Most surgical tissue repairs are complex and require the deployment of multiple suture anchors to anchor sutures and repair tissue in multiple locations. Typically single deployment inserters are utilized. However, the single anchor deployment inserters are more expensive as they utilize more material because the inserter must be disposed of after deployment of only a single suture anchor.
The present inventors recognize the tissue repair device can be configured to retain and organize the suture(s) coupled to the soft anchor such that the suture(s) do not become tangled during loading and deployment of the suture anchors in sequence. Furthermore, present inventors recognize the tissue repair device can be configured such that the suture anchors can be coupled to tissue via one or more sutures prior to deployment of the suture anchor while the suture anchor is still on and coupled to the tissue repair device. This can save the surgeon significant time and reduce surgical complexity.
To further illustrate the devices and related methods disclosed herein, a non-limiting list of examples is provided below. Each of the following non-limiting examples can stand on its own, or can be combined in any permutation or combination with any one or more of the other examples.
Corresponding reference characters indicate corresponding parts throughout the several views. Inserters in the drawings are not necessarily drawn to scale. The configurations shown in the drawings are merely examples, and should not be construed as limiting the scope of the invention in any manner.
DETAILED DESCRIPTIONTo repair tissue (including both soft tissue and bone) in the human body a surgeon can deploy two or more soft anchors connected by a loop of suture. For example, the two or more soft anchors and the loop of suture can be utilized to repair a tear in tissue such as a meniscus or can be used to reattach muscle to bone. These soft anchors are referred to as “soft” herein as they are formed of material(s) that are flexible and/or deformable, such as a suture sleeve or other suture material. These soft suture anchors can be constructed as tubes that are collapsible once tension is applied to the suture. Soft anchors are known and include the JuggerKnot® Soft Anchor manufactured and sold by Zimmer Biomet of Warsaw, IN. Soft suture anchor such as the suture anchor 104 shown can be an elongated member having first and second ends. The first and second ends can be blunt and substantially perpendicular to a longitudinal axis of the suture anchor 104. The suture anchor 104 can be made of resorbable or non-resorbable materials, including braided suture, sponges and sponge-like materials in solid form, perforated materials, woven/braided from biocompatible materials or fibers, such as, for example, polymer, polyester, polyethylene, cotton, silk, or other natural or synthetic materials, including sponges and sponge-like materials. The suture anchor 104 can also be an elongated tubular or solid member or a two-dimensional member with or without internal bores. The suture anchor 104 can have any properties that allow the suture anchor 104 to change shape. The suture anchor 104 can be, for example, collapsible, compliant, flexible, foldable, squashable, squeezable, deformable, limp, flaccid, elastic, low-modulus, soft, spongy, perforated or any other flexible member which can change shape. In some aspects, the suture anchor 104 can be coated with biological or biocompatible coatings, and it can also be soaked in platelets and other biologics, which can be easily absorbed by the suture anchor 104. The present suture anchor 104 can utilize aspects of known techniques and devices such as ZipLoop® Technology from Zimmer Biomet. ZipLoop® Technology allows one or more sutures to be passed through or otherwise coupled to the suture anchor 104 so as to attach the one or more sutures to the suture anchor 104.
The surgeon can optionally use a tissue repair device (sometimes called a deployment device, inserter or simply device herein) to aid in deploying the anchor(s). The tissue repair device may have a needle to pierce the tissue or bone on adjacent the tear. The tissue repair device can then deploy a first of the two or more anchors, retract and deploy the second of the two or more anchors in a sequential process. This process can be continued with a third soft anchor, a fourth soft anchor, etc. It is contemplated that the surgeon can then pull on the suture to draw the two or more deployed anchors together, which can close the tear and/or re-attach the tendon or muscle to bone. The surgeon can then cut the suture. This process is further illustrated and described in reference to some of the FIGURES that follow. Deployment of a single soft anchor and creation of a loop for connection of additional anchors (or other suture or devices) is also contemplated in some aspects of this application.
There is ongoing effort to improve tissue repair devices, such as making them easier to use and have them provide for more repeatable results during a repair procedure. The tissue repair devices discussed below in further detail can provide improvements in these and other areas. For example, the present tissue repair device uses an anchor formed from a deformable material. This can be preferable to using a hard-plastic anchor, made from a relatively hard material, such as polyether ether ketone (PEEK). For example, in cases where the suture pulls through the tissue, the anchor can be dislodged within the joint or surgical space. A hard-plastic anchor can cause joint damage by moving within the joint space. Chances of damage can be reduced with a soft anchor. Furthermore, the present meniscal repair device uses two suture strands across the tissue, rather than a single suture strand, which can distribute the suture force over a larger tissue area and therefore reduce the likelihood that suture will rip through the tissue. The tissue repair devices of the present can deploy the anchors without using any pre-tied suture knots, which could rub against the femur.
Tissue repair devices for deploying soft anchors connected with the suture loop, such as those of application Ser. No. 15/482,106 (now U.S. Pat. No. 10,499,902) and application Ser. No. 16/251,342 (now U.S. Pat. No. 11,116,495 are known. These applications owned by the applicant and the contents of both are incorporated herein by reference in their entirety. The present application provides further examples of tissue repair devices that can be utilized for deploying soft anchors. One or more of the tissue repair devices disclosed herein may be preferred by a physician according to the physician's individual requirements or preferences.
The soft anchor 104 can be preloaded onto the tissue repair device 102 prior to surgery. The shaft 106 can be configured as needle. The point 108 can be optional and can be distal of the eyelet 110. The eyelet 110 can be configured to receive and carry the soft anchor 104. The one or more loops 112 can be fixed or adjustable and can be formed of wire, suture or another material. The point 108 can be configured for punching tissue for deployment of the soft anchor 104.
The tissue repair device 302 includes a proximal portion 304 and a distal portion 306 (
Each spool can be coupled with an associated locking mechanism. Thus the first spool 320 can be coupled to the first locking mechanism 322, the second spool 324 can be coupled to the second locking mechanism 326, etc. The locking mechanisms 322, 326, 330 and 334 can pass through the actuator 310 and can interact with the actuator 310 as further discussed herein.
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The tissue repair device 402 can include two assemblies of spools rather than four as previously described. The end effector 416 can be configured to deploy two anchors into tissue rather than four anchors. To this end, the end effector 416 may employ the actuators 310 and 310A as previously described and a single notch 440.
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The tissue repair device 502 can include an insert 504 at a distal end such as a drill bit, sharp or other puncture apparatus. This insert 504 can be temporary and can be coupled to or decoupled from the tissue repair device 502. The insert 504 can be used to puncture the tissue (e.g., bone) and can be attachable to or can be a separate component that passes through an end effector 516. The end effector 516 can be configured to carry and pass the soft anchor 104 in a manner similar to that described previously herein. The soft anchor 104 can be used with a wire loop 506 of a suture passer (similar to the one or more loops 112 of
It is further contemplated that the methodology of
The surgeon can choose to position the two or more anchors in a suitable pattern that is matched to address the injury and complete a repair. In some examples, the surgeon can position one anchor above the other, in a so-called horizontal mattress pattern. In other examples, the surgeon can position the anchors side by side, in a so-called vertical mattress pattern. The vertical mattress stitching pattern can be well-suited for meniscal repairs due to its ability to achieve deep and superficial wound closure, edge eversion and precise vertical alignment of the superficial wound margins. The surgeon can insert the first anchor on the inferior meniscal rim. The surgeon can insert the second anchor superior to the tear on the meniscal rim. Implants in this superior meniscal location can require shorter distances of deployment, since the depth of meniscus can be less than the depth at the inferior location. To decrease the needle depth for the superior position, the surgeon can adjust an adjustable depth stop until the needle reaches a desired depth.
Anchors can be or may not be connected to together with strands of suture cinched or otherwise coupled. Thus, in some cases, after deployment of the final soft anchor, the surgeon can tension sutures that connect the first, second, etc. anchors together. For example, after the surgeon retracts the tissue repair device from the joint, a suture loop and a single strand of suture can protrude from the access portal. The suture loop and single strand of suture can be formed from a single piece of suture run through itself and configured as an adjustable loop. If the surgeon pulls on the loop, the loop does not increase in size. If the surgeon pulls on the single strand of suture, the loop shrinks. Deploying the anchors as described above can produce a small loop of suture inside the joint, a larger loop of suture emerging from the skin, and a free strand of suture emerging from the skin. The surgeon can pull on the larger loop to set the anchors at the repair site as desired and can pull the single strand to contract the large loop down to the surface of the tissue such as illustrated in
As discussed previously, the anchors 104, etc. discussed herein can be “soft” (i.e., they can be made from a relatively soft material such as fabric or suture), and thus they can bend, flex and/or deform under the force of a suture or other inserter(s) on the repair device. In some examples, the anchors 104, etc. can be nominally shaped as cylinders, or tubes having a circular or elongated cross-section, but can be configured to deform during assembly into the repair device and/or during deployment.
Many of the FIGURES herein illustrate components of the repair device including the anchors in a highly schematic manner. This is done to better illustrate interaction of various components of the repair device. However, it is recognized that the anchors 104, etc. can have other shapes and can be deformable as discussed above. Similarly, other components of the repair device can have shapes different from those illustrated herein.
According to other examples contemplated herein not all anchors may not be soft and can be made from non-deformable material such as a hard plastic, etc. Thus, according to some examples the anchor(s) can have a cross-section or other geometry that is invariant. In these examples, the anchor(s) can have a hollow interior formed by a tubular shape of the anchor(s).
Although two anchors are illustrated in some embodiments, it is contemplated that further anchors (e.g., three, four or more) could be used with and stored in the repair device. Additionally, the anchors 104, etc. can be differently sized/shaped relative to one another and/or can be formed of different material relative to one another according to some examples.
It will be understood that the foregoing are merely examples, and that other deployment schemes and device configurations can also be used. Furthermore, combinations of the various foregoing examples can be used together as desired according to further contemplated examples. It will be understood that one of ordinary skill in the art can modify the foregoing devices to achieve a desirable deployment of the first anchor and the second anchor.
While this invention has been described as having example designs, the present invention can be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains and which fall within the limits of the appended claims.
Claims Related Examples/Aspects/TechniquesIn some aspects, the techniques described herein relate to an end effector for a tissue repair device, including: a housing defining a central slot with one or more notches in communication therewith and a first actuator moveable within the central slot; a deformable first anchor selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue; and a deformable second anchor configured to be received in at least one of the one or more notches, wherein the second anchor is moveable from the at least one of the one or more notches and is selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue.
In some aspects, the techniques described herein relate to an end effector, further including an insert configured to couple with the housing and configured to puncture tissue.
In some aspects, the techniques described herein relate to an end effector, wherein the first actuator is configured to extend distal from a distal opening of the slot and is configured as a needle to puncture tissue.
In some aspects, the techniques described herein relate to a tissue repair device, including: an end effector having a housing a defining a central slot and a first actuator moveable within the central slot; at least a first deformable first anchor carried by the end effector and selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue; a handle having a spool and a locking mechanism configured to selectively control movement of the spool; a shaft coupling the handle with the end effector; and one or more sutures coupling the first anchor to the spool.
In some aspects, the techniques described herein relate to a tissue repair device, further including a second actuator configured to selectively move the first actuator and the locking mechanism.
In some aspects, the techniques described herein relate to a tissue repair device, further including: a deformable second anchor received in the end effector, wherein the second anchor is selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue; and a second one or more sutures coupling the second anchor to a second spool.
In some aspects, the techniques described herein relate to a tissue repair device, wherein the housing forms one or more notches in communication with the central slot, wherein the second anchor is configured to be received in at least one of the one or more notches, and wherein the second anchor is moveable from the at least one of the one or more notches.
In some aspects, the techniques described herein relate to a tissue repair device, wherein the second anchor is moveable from the at least one of the one or more notches by the spool moving to pull the sutures coupled to the second anchor.
In some aspects, the techniques described herein relate to a tissue repair device, further including: at least a second spool; at least a second anchor, wherein the at least the second anchor is carried by the end effector and is coupled to the at least the second spool by at least one suture.
In some aspects, the techniques described herein relate to a tissue repair device, further including at least a second locking mechanism coupled to the at least the second spool.
In some aspects, the techniques described herein relate to a tissue repair device, wherein the at least the second spool includes three or more spools and the at least the second anchor includes three or more anchors.
In some aspects, the techniques described herein relate to a tissue repair device, further including an insert configured to couple with the housing and configured to puncture tissue.
In some aspects, the techniques described herein relate to a tissue repair device, wherein the first actuator is configured to extend distal from a distal opening of the slot and is configured as a needle to puncture tissue.
In some aspects, the techniques described herein relate to a tissue repair device, including: a housing defining a central slot with one or more notches in communication therewith and a first actuator moveable within the central slot; a deformable first anchor selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue; and a deformable second anchor configured to be received in at least one of the one or more notches, wherein the second anchor is moveable from the at least one of the one or more notches and is selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue; a handle having configured to selectively control movement of at least the second anchor from the one or more notches; a shaft coupling the handle with the end effector; and one or more sutures coupling at least the second anchor to the handle.
In some aspects, the techniques described herein relate to a tissue repair device, wherein the handle includes a spool that captures the one or more sutures.
In some aspects, the techniques described herein relate to a tissue repair device, wherein the handle includes a locking mechanism configured to selectively control movement of the spool.
In some aspects, the techniques described herein relate to a tissue repair device, further including a second actuator configured to selectively move the first actuator and the locking mechanism.
In some aspects, the techniques described herein relate to a tissue repair device, further including: at least a second spool; at least a second anchor, wherein the at least the second anchor is carried by the end effector and is coupled to the at least the second spool by at least one suture.
In some aspects, the techniques described herein relate to a tissue repair device, further including at least a second locking mechanism coupled to the at least the second spool.
In some aspects, the techniques described herein relate to a tissue repair device, wherein the at least the second spool includes three or more spools and the at least the second anchor includes three or more anchors.
In some aspects, the techniques described herein include a method of coupling soft tissue to bone with one or more suture. The method can optionally include coupling the one or more suture to the soft tissue, coupling the one or more suture to a deformable first anchor while the deformable first anchor is coupled to an end effector of a tissue repair device, and deploying the deformable first anchor from the end effector into the bone with the one or more suture coupled thereto after the coupling the one or more suture to the deformable first anchor.
In some aspects, the method can optionally include coupling the one or more suture to the deformable first anchor includes passing the one or more suture through a body passage of the deformable first anchor using a loop of a suture passer, wherein the loop is configured to receive the one or more suture.
In some aspects, the method can optionally further include puncturing the bone with an inserter of the tissue repair device.
In some aspects, the method can further optionally include: coupling the one or more suture to a deformable second anchor while the deformable second anchor is coupled to the end effector of the tissue repair device and deploying the deformable second anchor with the one or more suture coupled thereto into the bone after the coupling the one or more suture to the deformable first anchor and the deformable second anchor.
In some aspects, any of the tissue repair devices described herein can be used with the method.
Claims
1. An end effector for a tissue repair device, comprising:
- a housing defining a central slot with one or more notches in communication therewith and a first actuator moveable within the central slot;
- a deformable first anchor selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue; and
- a deformable second anchor configured to be received in at least one of the one or more notches, wherein the second anchor is moveable from the at least one of the one or more notches and is selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue.
2. The end effector of claim 1, further comprising an insert configured to couple with the housing and configured to puncture tissue.
3. The end effector of claim 1, wherein the first actuator is configured to extend distal from a distal opening of the slot and is configured as a needle to puncture tissue.
4. A tissue repair device, comprising:
- an end effector having a housing a defining a central slot and a first actuator moveable within the central slot;
- at least a first deformable first anchor carried by the end effector and selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue;
- a handle having a spool and a locking mechanism configured to selectively control movement of the spool;
- a shaft coupling the handle with the end effector; and
- one or more sutures coupling the first anchor to the spool.
5. The tissue repair device of claim 4, further comprising a second actuator configured to selectively move the first actuator and the locking mechanism.
6. The tissue repair device of claim 4, further comprising:
- a deformable second anchor received in the end effector, wherein the second anchor is selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue; and
- a second one or more sutures coupling the second anchor to a second spool.
7. The tissue repair device of claim 6, wherein the housing forms one or more notches in communication with the central slot, wherein the second anchor is configured to be received in at least one of the one or more notches, and wherein the second anchor is moveable from the at least one of the one or more notches.
8. The tissue repair device of claim 7, wherein the second anchor is moveable from the at least one of the one or more notches by the spool moving to pull the sutures coupled to the second anchor.
9. The tissue repair device of claim 4, further comprising:
- at least a second spool; and
- at least a second anchor, wherein the at least the second anchor is carried by the end effector and is coupled to the at least the second spool by at least one suture.
10. The tissue repair device of claim 9, further comprising at least a second locking mechanism coupled to the at least the second spool.
11. The tissue repair device of claim 9, wherein the at least the second spool comprises three or more spools and the at least the second anchor comprises three or more anchors.
12. The tissue repair device of claim 4, further comprising an insert configured to couple with the housing and configured to puncture tissue.
13. The tissue repair device of claim 4, wherein the first actuator is configured to extend distal from a distal opening of the slot and is configured as a needle to puncture tissue.
14. A tissue repair device, comprising:
- an end effector with a housing defining a central slot with one or more notches in communication therewith and a first actuator moveable within the central slot;
- a deformable first anchor selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue; and
- a deformable second anchor configured to be received in at least one of the one or more notches, wherein the second anchor is moveable from the at least one of the one or more notches and is selectively engageable by the first actuator to move along the central slot to release the first anchor from the housing into tissue:
- a handle having configured to selectively control movement of at least the second anchor from the one or more notches;
- a shaft coupling the handle with the end effector; and
- one or more sutures coupling at least the second anchor to the handle.
15. The tissue repair device of claim 14, wherein the handle includes a spool that captures the one or more sutures.
16. The tissue repair device of claim 15, wherein the handle includes a locking mechanism configured to selectively control movement of the spool.
17. The tissue repair device of claim 14, further comprising a second actuator configured to selectively move the first actuator and one or more locking mechanisms of the handle.
18. The tissue repair device of claim 14, further comprising:
- a plurality of spools within the handle each of the plurality of spools coupled to the one or more sutures; and
- one or more anchors in addition to the first anchor and the second anchor, wherein the at one or more anchors are carried by the end effector and are coupled to respective ones of the plurality of spools.
19. The tissue repair device of claim 18, further comprising at least a second locking mechanism coupled to the plurality of spools.
20. The tissue repair device of claim 18, wherein the plurality of spools comprises three or more spools and the one or more anchors comprises two or more anchors.
21. A method of coupling soft tissue to bone with one or more suture, the method comprising:
- coupling the one or more suture to the soft tissue;
- coupling the one or more suture to a deformable first anchor while the deformable first anchor is coupled to an end effector of a tissue repair device; and
- deploying the deformable first anchor from the end effector into the bone with the one or more suture coupled thereto after the coupling the one or more suture to the deformable first anchor.
22. The method of claim 21, wherein the coupling the one or more suture to the deformable first anchor includes passing the one or more suture through a body passage of the deformable first anchor using a loop of a suture passer, wherein the loop is configured to receive the one or more suture.
23. The method of claim 21, further comprising puncturing the bone with an inserter of the tissue repair device.
24. The method of claim 21, further comprising:
- coupling the one or more suture to a deformable second anchor while the deformable second anchor is coupled to the end effector of the tissue repair device; and
- deploying the deformable second anchor with the one or more suture coupled thereto into the bone after the coupling the one or more suture to the deformable first anchor and the deformable second anchor.
Type: Application
Filed: Apr 12, 2023
Publication Date: Oct 19, 2023
Inventors: Christopher M. Palese (Warsaw, IN), Daniel R. Norton (Warsaw, IN), Nathan A. Winslow (Scottsdale, AZ)
Application Number: 18/133,848